Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-05T00:47:18.534Z Has data issue: false hasContentIssue false
  • English
  • Français

Non-pharmacological interventions for reducing aggression and violence in serious mental illness: A systematic review and narrative synthesis

Published online by Cambridge University Press:  23 March 2020

J Rampling ,
V Furtado ,
C Winsper ,
S Marwaha ,
G Lucca ,
M Livanou  and
SP Singh
J Rampling*
Affiliation:
Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Reaside Clinic, Birmingham, UK
V Furtado
Affiliation:
Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Reaside Clinic, Birmingham, UK Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL, UK
C Winsper
Affiliation:
Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL, UK
S Marwaha
Affiliation:
Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL, UK
G Lucca
Affiliation:
University of Milano-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126Milano, Italy
M Livanou
Affiliation:
Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL, UK
SP Singh
Affiliation:
Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL, UK
*
*Corresponding author. at: c/o Reaside Clinic, Birmingham Great Park, Birmingham B45 9EB, UK. E-mail address:[email protected] (J. Rampling).
Get access

Abstract

Background

For people with mental illness that are violent, a range of interventions have been adopted with the aim of reducing violence outcomes. Many of these interventions have been borrowed from other (offender) populations and their evidence base in a Serious Mental Illness (SMI) population is uncertain.

Aims

To aggregate the evidence base for non-pharmacological interventions in reducing violence amongst adults with SMI and PD (Personality Disorder), and to assess the efficacy of these interventions. We chose to focus on distinct interventions rather than on holistic service models where any element responsible for therapeutic change would be difficult to isolate.

Methods

We performed a systematic review and narrative synthesis of non-pharmacological interventions intended to reduce violence in a SMI population and in patients with a primary diagnosis of PD. Five online databases were searched alongside a manual search of seven relevant journals, and expert opinion was sourced. Eligibility of all returned articles was independently assessed by two authors, and quality of studies was appraised via the Cochrane Collaboration Tool for Assessing Risk of Bias.

Results

We included 23 studies of diverse psychological and practical interventions, with a range of experimental and quasi-experimental study designs that included 7 Randomised Controlled Trials (RCTs). The majority were studies of Mentally Disordered Offenders. The stronger evidence existed for patients with a SMI diagnosis receiving Cognitive Behavioural Therapy or modified Reasoning & Rehabilitation (R&R). For patients with a primary diagnosis of PD, a modified version of R&R appeared tolerable and Enhanced Thinking Skills showed some promise in improving attitudes over the short-term, but studies of Dialectical Behaviour Therapy in this population were compromised by high risk of experimental bias. Little evidence could be found for non-pharmacological, non-psychological interventions.

Conclusions

The evidence for non-pharmacological interventions for reducing violence in this population is not conclusive. Long-term outcomes are lacking and good quality RCTs are required to develop a stronger evidence base.

Keywords

Schizophrenia and psychosisPersonality disorderViolenceForensic psychiatryPsychotherapy
Type
Review
Information
European Psychiatry , Volume 34 , April 2016 , pp. 17 - 28
Copyright
Copyright © European Psychiatry 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Walsh, EBuchanan, AFahy, TViolence and schizophrenia: examining the evidence. Br J Psychiatry 2002;180: 490–495.CrossRefGoogle ScholarPubMed
Large, MNielssen, OViolence in first-episode psychosis: a systematic review and meta-analysis. Schizophr Res 2011;125(2–3):209–220.CrossRefGoogle ScholarPubMed
Yee, NLarge, MKemp, RNielssen, OSevere non-lethal violence during psychotic illness. Aust N Z J Psychiatry 2011;45(6):466–472.CrossRefGoogle ScholarPubMed
Fazel, SDinesh, JSerious mental disorder in 23,000 prisoners: a systematic review of 62 surveys. Lancet 2002;359: 545–550.CrossRefGoogle Scholar
Cuellar, ASnowden, LEwing, TCriminal records of persons served in the public Mental Health system. Psychiatr Serv 2007;58(1):114–120.CrossRefGoogle ScholarPubMed
Hodgins, SCalem, MShimel, RWilliams, AHarleston, DMorgan, Cet al.Criminal offending and distinguishing features of offenders among persons experiencing a first episode of psychosis. Early Intervent Psychiatry 2011;5(1):15–23.CrossRefGoogle ScholarPubMed
Fazel, SSeewald, KSevere mental illness in 33,588 prisoners worldwide: systematic review and meta-regression analysis. Br J Psychiatry 2012;200: 364–373.CrossRefGoogle ScholarPubMed
Yu, RGeddes, JRFazel, SPersonality disorders, violence, and antisocial behaviour: a systematic review and meta-regression analysis. J Personal Disord 2012;26(5):775–792.CrossRefGoogle ScholarPubMed
Volavka, JCzobor, PCitrome, LMcQuade, RCarson, WKostic, Det al.Efficacy of Aripiprazole against hostility in schizophrenia and schizoaffective disorder: data from 5 double-blind studies. J Clin Psychiatry 2005;66(11):1362–1366.CrossRefGoogle ScholarPubMed
Frogley, CTaylor, DDickens, GPicchioni, MA systematic review of the evidence of clozapine’s anti-aggressive effects. Int J Neuropsychopharmacol 2012;15: 1351–1371.CrossRefGoogle ScholarPubMed
Volavka, JAggression in psychoses. Adv Psychiatr 2014;2014:1–20. http://dx.doi.org/10.1155/2014/196281 [Article ID: 196281]CrossRefGoogle Scholar
Winsper, CSingh, SMarwaha, SAmos, TLester, HEverard, Let al.Pathways to violent behaviour during first episode psychosis: a report from the UK National EDEN study. JAMA Psychiatry 2013;70(12):1287–1293.CrossRefGoogle ScholarPubMed
Morgan, RFisher, WDuan, NMandracchia, JMurray, DPrevalence of criminal thinking among state prison inmates with serious mental illness. Law Hum Behav 2010;34: 324–336.CrossRefGoogle ScholarPubMed
Maden, AScott, FBurnett, RLewis, GSkapinakis, POffending in psychiatric patients after discharge from medium secure units: prospective national cohort study. BMJ 328 2004 1534CrossRefGoogle ScholarPubMed
Nilsson, TWallinius, MGustavson, CAnckarsäter, HKerekes, NViolent recidivism: a long-term follow-up study of mentally disordered offenders. PLoS ONE 2011;6(10):e2576810.1371/journal.pone.0025768CrossRefGoogle Scholar
Blackburn, R“What works” with mentally disordered offenders. Psychol Crime Law 2004;10(3):297–308.CrossRefGoogle Scholar
Ross, JQuayle, ENewman, ETansey, LThe impact of psychological therapies on violent behaviour in clinical and forensic settings: a systematic review. Aggress Violent Behav 2013;18: 761–773.CrossRefGoogle Scholar
Moher, DLiberati, ATetzlaff, JAltman, DGPRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151(4):264–269.CrossRefGoogle ScholarPubMed
Hockenhull, JWhittington, RLeitner, MBarr, WMcGuire, JCherry, Met al.A systematic review of prevention and intervention strategies for populations at high risk of engaging in violent behaviour: update 2002–2008. Health Technol Assess 2012;16(3):1–152.CrossRefGoogle Scholar
Morgan, RFlora, DKroner, DMills, JVarghese, FSteffan, JTreating offenders with mental illness: a research synthesis. Law Hum Behav 2010;36(1):37–50.CrossRefGoogle Scholar
Martin, MDorken, SWamboldt, AWootten, SStopping the revolving door: a meta-analysis on the effectiveness of interventions for criminally involved individuals with major mental disorders. Law Hum Behav 2012;36(1):1–12.CrossRefGoogle ScholarPubMed
Blackburn, RLogan, CDonnelly, JRenwick, SPersonality disorders, psychopathy and other disorders: co-morbidity among patients at English and Scottish high-security hospitals. J Forensic Psychiatry Psychol 2003;14(1):111–137.CrossRefGoogle Scholar
Fazel, SZetterqvist, JLarsson, HLångström, NLichtenstein, PAntipsychotics, mood stabilisers, and the risk of violent crime. Lancet 2014;384: 1206–1214.CrossRefGoogle ScholarPubMed
Novaco, RAnger as a risk factor for violence among the mentally disorderedMonahan, J.Steadman, H.Violence and mental disorder 1994 University of Chicago Press Chicago269–295.Google Scholar
Cochrane Collaboration’s Tool for assessing risk of bias. http://www.ohg.cochrane.org/sites/ohg.cochrane.org/files/uploads/Risk%20of%20bias%20assessment%20tool.pdf [Last accessed 6/2/2015].Google Scholar
Haddock, GBarrowclough, CShaw, JDunn, GNovaco, RTarrier, NCognitive-behavioural therapy v. social activity therapy for people with psychosis and a history of violence: randomised controlled trial. Br J Psychiatry 2009;194: 152–157.CrossRefGoogle Scholar
Hornsveld, RNijman, HEvaluation of a cognitive-behavioral program for chronically psychotic forensic inpatients. Int J Law Psychiatry 2005;28: 246–254.CrossRefGoogle ScholarPubMed
Davidson, KTyrer, PTata, PCooke, DGumley, AFord, Iet al.Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial. Psychol Med 2009;39: 569–577.CrossRefGoogle Scholar
Yates, KKunz, MKhan, AVolavka, JRabinowitz, SPsychiatric patients with histories of aggression and crime five years after discharge from a cognitive-behavioral program. J Forensic Psychiatry Psychol 2010;21(2):167–188.CrossRefGoogle Scholar
Ross, RFabiano, ETime to think: a cognitive model of delinquency prevention and offender rehabilitation Johnson City, TN: Institute of Social Sciences and Arts; 1985.Google Scholar
Cullen, AClarke, AKuipers, EHodgins, SDean, KFahy, TA multisite randomised trial of a cognitive skills programme for male mentally disordered offenders: social-cognitive outcomes. Psychol Med 2012;42: 557–569.CrossRefGoogle Scholar
Cullen, AClarke, AKuipers, EHodgins, SDean, KFahy, TA multisite randomised trial of a cognitive skills programme for male mentally disordered offenders: violence and antisocial behaviour outcomes. J Consult Clin Psychol 2012;80(6):1114–1120.CrossRefGoogle Scholar
Clarke, ACullen, AWalwyn, RFahy, TA quasi-experimental pilot study of the Reasoning and Rehabilitation programme with mentally disordered offenders. J Forensic Psychiatry Psychol 2010;21(4):490–500.CrossRefGoogle Scholar
Young, SChick, KGudjonsson, GA preliminary evaluation of reasoning and rehabilitation 2 in mentally disordered offenders (R&R2M) across two secure forensic settings in the United Kingdom. J Forensic Psychiatry Psychol 2010;21(3):336–349.CrossRefGoogle Scholar
Rees-Jones, AGudjonsson, GYoung, SA multi-site controlled trial of a cognitive skills program for mentally disordered offenders. BMC Psychiatry 12 2012 44CrossRefGoogle ScholarPubMed
Yip, VGudjonsson, GPerkins, DDoidge, AHopkin, GYoung, SA non-randomised controlled trial of the R&R2MHP cognitive skills program in high risk male offenders with severe mental illness. BMC Psychiatry 13 2013 267CrossRefGoogle Scholar
Jotangia, ARees-Jones, AGudjonsson, GHYoung, SA multi-site controled trial of the R&R2MHP cognitive skills program for mentally disordered female offenders. Int J Offender Ther Comp Criminol 2015;59(5):539–559.CrossRefGoogle Scholar
Young, SHopkin, GPerkins, DFarr, CDoidge, AGudjonsson, GA controlled trial of a cognitive skills program for personality-disordered offenders. J Atten Disord 2013;17(7):598–607.CrossRefGoogle ScholarPubMed
Evershed, STennant, ABoomer, DRees, ABarkham, MWatson, APractice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: a pragmatic and non-contemporaneous comparison. Crim Behav Ment Health 2003;13: 198–213.CrossRefGoogle ScholarPubMed
Long, CFulton, BDolley, OHollin, CDealing with feelings: the effectiveness of cognitive behavioural group treatment for women in secure settings. Behav Cogn Psychother 2010;39: 243–247.CrossRefGoogle ScholarPubMed
Tapp, JFellowes, EWallis, NBlud, LMoore, EAn evaluation of the Enhanced Thinking Skills (ETS) programme with mentally disordered offenders in a high security hospital. Legal Criminol Psychol 2009;14: 201–212.CrossRefGoogle Scholar
Doyle, MKhanna, TLennox, CShaw, JHayes, ATaylor, Jet al.The effectiveness of an enhanced thinking skills programme in offenders with antisocial personality traits. J Forensic Psychiatry Psychol 2013;24(1):1–15.CrossRefGoogle Scholar
Hornsveld, RNijman, HKraaimaat, FAggression Control Therapy for violent forensic psychiatric patients: first results. Psychol Crime Law 2008;14(1):1–18.CrossRefGoogle Scholar
Wilson, CGandolfi, SDudley, AThomas, BTapp, JMoore, EEvaluation of anger management groups in a high-security hospital. Crim Behav Ment Health 2013;23: 356–371.CrossRefGoogle Scholar
Tarrier, NDolan, MDoyle, MDunn, GShaw, JBlackburn, RExploratory randomized clinical trial of schema modal therapy in the personality disorder service at Ashworth Hospital UK: Ministry of Justice; 2010 [Research Series 5/10]Google Scholar
Bernstein, DNijman, HKaros, KKeulen-de Vos, Mde Vogel, VLucker, TSchema therapy for forensic patients with personality disorders: design and preliminary findings of a multicentre randomised clinical trial in the Netherlands. Int J Forensic Ment Health 2012;11: 312–324.CrossRefGoogle Scholar
Nurenberg, JRSchleifer, SJShaffer, TMYellin, MDesai, PJAmin, Ret al.Animal-Assisted therapy with chronic psychiatric inpatients: equine-assisted psychotherapy and aggressive behavior. Psychiatr Serv 2015;66(1):80–86.CrossRefGoogle ScholarPubMed
Bruce, MCrowley, SJeffcote, NCoulston, BCommunity DSPD pilot services in South London: rates of reconviction and impact of supported housing on reducing recidivism. Crim Behav Ment Health 2014;24: 129–140.CrossRefGoogle ScholarPubMed
Troquette, Nvan den Brink, RBeintema, HMulder, Tvan Os, TSchoevers, Ret al.Risk assessment and shared care planning in out-patient forensic psychiatry: cluster randomised controlled trial. Br J Psychiatry 2013;202: 365–371.CrossRefGoogle Scholar
McMurran, MHuband, NOverton, ENon-completion of personality disorder treatments: a systematic review of correlates, consequences and interventions. Clin Psychol Rev 2010;30: 277–287.CrossRefGoogle ScholarPubMed
Anderson, AWest, SGViolence against Mental Health professionals: when the treater becomes the victim. Innov Clin Neurosci 2011;8(3):34–39.Google ScholarPubMed
Fazel, SLangstrom, NHjern, AGrann, MLichtenstein, PSchizophrenia, substance abuse, and violent crime. JAMA 2009;301(19):2016–2023.CrossRefGoogle ScholarPubMed
Scott, DAMcGilloway, SDempster, MBrowne, FDonnelly, MEffectiveness of criminal justice liaison and diversion services for offenders with mental disorders: a review. Psychiatr Serv 2013;64(9):843–849.CrossRefGoogle ScholarPubMed
Wilson, DTien, GEaves, DIncreasing the community tenure of mentally disordered offenders: an assertive case management program. Int J Law Psychiatry 1995;18: 61–69.CrossRefGoogle Scholar
Walsh, EGilvarry, CSamele, CHarvey, KManley, CTyrer, Pet al.Reducing violence in severe mental illness: randomised controlled trial of intensive case management compared with standard care. BMJ 2001;323: 1–5.CrossRefGoogle ScholarPubMed
Stevens, HAgerbo, EDean, KMortensen, PBNordentoft, MReduction of crime in first-onset psychosis: a secondary analysis of the OPUS randomized trial. J Clin Psychiatry 2013;74(5):e439–e444.CrossRefGoogle ScholarPubMed
Supplementary material: File

Rampling et al. supplementary material

Supplementary materials

Download Rampling et al. supplementary material(File)
File 64.5 KB
Submit a response

Comments

No Comments have been published for this article.